Ppt COVID vaccination

This important presentation encompasses all the vaccines of COVID at current point of time; it's mechanism of action, its efficacy data's and advantages and disadvantages

1. COVID-19 Vaccination & Prevention strategies Dr. Shinjan Patra

2. Introduction COVID-19 has been the cause of distress & ailment all throughout the globe for last 18 months C linical manifestations progressed from pneumonia to ARDS

3. Complications Typically associated with the phenomenon of Cytokine storm Lung injury leads to reduced surfactant & reduced gas exchange in the alveoli Leads to massive vascular inflammation, shock, hypotension, disseminated intravascular coagulation & multi-organ dysfunction Vaccination holds the key to tackle his epidemic

4. Outline Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

5. Early days Vaccine for an infectious disease never been produced in less than several years No vaccine existed for preventing a corona virus infection in humans Established body of knowledge about the structure and function of corona-viruses causing diseases like SARS CoV-1 & MERS E nabled accelerated development of various vaccine technologies during early 2020 On 10 January 2020, the SARS-CoV-2 genetic sequence data shared By 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19

6. Initiation Since January 2020, vaccine development expedited via unprecedented collaboration in the multinational pharmaceutical industry and between governments

7. Basic steps Safety Targeting vulnerable populations Need for vaccine efficacy breakthroughs Duration of vaccination protection Special delivery systems (such as oral or nasal, rather than by injection) Dose regimen Stability and storage characteristics Dissemination of the licensed vaccine

8. Challenges Urgency compressed schedules that shortened the standard vaccine development timeline Compromising safety assurance Research at universities obstructed by physical distancing and closing Virus proved to be a "moving target" of changing transmission rates across and within countries Compete for trial participants

9. Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

10. Authorization 17 vaccines authorized by at least one national regulatory authority for public use RNA vaccines Pfizer– BioNTech Viral Vector Vaccines Oxford-AstraZeneca Moderna Sputnik Light CVnCoV Sputnik V Inactivated vaccines BBIBP- CorV Johnson & Johnson CoronaVac Convidecia Covaxin Protein subunit vaccine EpiVacCorona WIBP- CorV RBDDimer CoviVac Minhai-Kangtai QazVac

11. Others in pipeline 308 vaccine candidates are in various stages of development With 73 in clinical research 24 in Phase I trials 33 in Phase I–II trials 16 in Phase III development

12. First approval On 2/12/20 UK’s Medicines and Healthcare products Regulatory Agency (MHRA) gave temporary regulatory approval for the Pfizer– BioNTech vaccine On 1/01/21, (DCGI) approved emergency use of the Oxford–AstraZeneca vaccine (Covishield) in India

13. Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

14. Platform & target Most of the platforms of vaccine candidates in clinical trials focused on the spike protein and its variants as the primary antigen Platform Being developed in 2020 involved nucleic acid technologies (nucleoside-modified messenger RNA and DNA), non-replicating viral vectors, peptides, recombinant proteins, live attenuated viruses and inactivated viruses

15. Next generation strategies Precise targeting of COVID‑19 infection mechanisms Use a 2P mutation to lock the spike protein into its prefusion configuration, stimulating an immune response to the virus before it attaches to a human cell

16. RNA vaccine When introduced into a tissue, acts as mRNA to cause the cells to build the foreign protein and stimulate an adaptive immune response Delivery of mRNA is achieved by a co-formulation of the molecule into lipid nano -particles which protect the RNA strands and help their absorption into the cells

17. Approval status First to be approved in US, UK, EU In January 2021, Pfizer– BioNTech and the Moderna got approval In February 2021, the CVnCoV RNA vaccine from CureVac got authorization in EU Allergic reactions rare

18. Inactivated virus vaccines Consist of virus particles that have been grown in culture and then are killed using a method such as heat or formaldehyde to lose disease producing capacity, while still stimulating an immune response

19. Adenovirus vector vaccines Non-replicating viral vector vaccines, using an adenovirus shell containing DNA that encodes a SARS‑CoV‑2 protein Convidecia and the Johnson & Johnson COVID-19 vaccine are both one-shot vaccines which offer less complicated logistics and can be stored under ordinary refrigeration for several months

20. Subunit vaccines Present one or more antigens without introducing whole pathogen particles Antigens involved are often protein subunits, but can be any molecule that is a fragment of the pathogen

21. Other types In clinical trials include Virus-like particle vaccines Multiple DNA plasmid vaccines Lentivirus vector vaccines Conjugate vaccine Vesicular stomatitis virus displaying the SARS‑CoV‑2 spike protein

22. Formulation To enhance immunogenicity Particularly effective for technologies using the inactivated virus and recombinant protein-based or vector-based vaccines Aluminum salts, the first adjuvant used for licensed vaccines, the adjuvant of choice in some 80% vaccines

23. Outline Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

24. Efficacy Not straightforward to compare the efficacies of the different vaccines because the trials were run with different populations, geographies and variants of the virus

25. Lineage B.1.1.7 (alpha) Identified in Dec’20 in UK Results suggest protection from the Pfizer- BioNTech and Moderna vaccines Oxford–AstraZeneca had an efficacy of 42–89% versus 71–91% against non-B.1.1.7 variants Wang P, Nair MS, Liu L, Iketani S, Luo Y, Guo Y, et al. (March 2021).  "Antibody Resistance of SARS-CoV-2 Variants B.1.351 and B.1.1.7" .  Nature . 593 (7857): 130–35 Emary KR, Golubchik T, Aley PK, Ariani CV, Angus BJ, Bibi S, et al. (2021). "Efficacy of ChAdOx1 nCoV-19 (AZD1222) Vaccine Against SARS-CoV-2 VOC 202012/01 (B.1.1.7)

26. Lineage B.1.351 (Beta) First detected in Dec’20 in South Africa Decreased neutralizing activity of Moderna and Pfizer- BioNTech vaccines On 1 April 2021, an update on a Pfizer/ BioNTech stated that the vaccine 100% effective Johnson & Johnson, reported the level of protection 72% in the United States and 57% in South Africa Reduced efficacy of the Oxford–AstraZeneca Hoffmann M, Arora P, Gross R, Seidel A, Hoernich BF, Hahn AS, et al. (March 2021).  "1 SARS-CoV-2 variants B.1.351 and P.1 escape from neutralizing antibodies" .  Cell .  184  (9): 2384–2393.e12

27. Lineage P.1 (Gamma) Initially identified in Brazil Seems to partially escape vaccination with the Pfizer- BioNTech Hoffmann M, Arora P, Gross R, Seidel A, Hoernich BF, Hahn AS, et al. (March 2021).  "1 SARS-CoV-2 variants B.1.351 and P.1 escape from neutralizing antibodies" .  Cell .  184  (9): 2384–2393.e12

28. Lineage B.1.617 (Kappa & Delta) First discovered in India Mostly detected after Jan’21 Spike mutations D111D, G142D,P681R, E484Q and L452R,the latter two of which may cause it to easily avoid antibodies Neutralized by Covaxin Covishield 60% effective Principles of epidemiology, Section 8: Concepts of disease occurrence" . U.S.  Centers for Disease Control and Prevention  (CDC). 18 May 2012.  Archived  from the original on 6 April 2020. Retrieved 6 May 2020.

29. Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

30. Oxford–AstraZeneca ( Vaxzevria , Covishield) Developers Country of origin Technology Doses ( Interval) Storage Pre-marketing study Post-marketing study University of Oxford, AstraZeneca, CEPI US, Sweden Adenovirus vector 2 doses 4–12 weeks 2–8 °C Phase III (30,000) Interventional; randomized, placebo-controlled study for efficacy, safety, and Immunogenicity. Overall efficacy of 76% after the first dose and 81% after a second dose taken 12 weeks or more after the first Phase IV (10,000) Interventional, Nonrandomized undergoing Voysey M, Costa Clemens SA, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. (March 2021).  "Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials" .  Lancet .  397  (10277): 881–91.  doi : 10.1016/S0140-6736(21)00432-3

31. Pfizer– BioNTech Developers Country of origin Technology Doses ( Interval) Storage Pre-marketing study Post-marketing study BioNTech , Pfizer Germany US RNA ( modRNA in lipid nanoparticles ) 2 doses 3–4 weeks −70 ± 10 °C Phase III (43,448) Randomized, placebo-controlled. Positive results from an interim analysis were announced on 18/11 2020 and published on 10/12/ 2020 reporting an overall efficacy of 95% Phase IV (10,000) Interventional, Nonrandomized undergoing Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. (December 2020).  "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine" .  The New England Journal of Medicine .  383  (27): 2603–15.  doi : 10.1056/NEJMoa2034577

32. Sputnik V Developers Country of origin Technology Doses ( Interval) Storage Pre-marketing study Post-marketing study Gamaleya Research Institute of Epidemiology and Microbiology Russia Adenovirus vector (recombinant Ad5 and Ad26 ) 2 doses 3 weeks ≤−18 °C Phase III (40,000) Randomized double blind, Placebo controlled to evaluate efficacy, immunogenicity, and safety. Interim analysis from the trial published in The Lancet, indicating 91.6% efficacy without unusual side effects Logunov DY, Dolzhikova IV, Shcheblyakov DV, Tukhvatulin AI, Zubkova OV, Dzharullaeva AS, et al. (February 2021).  "Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia" .  Lancet .  397  (10275): 671–81.  doi : 10.1016/S0140-6736(21)00234-8

33. BBV152 (Covaxin) Developers Country of origin Technology Doses ( Interval) Storage Pre-marketing study Post-marketing study Bharat Biotech, Indian Council of Medical Research India Inactivated SARS‑CoV‑2 ( vero cells) 2 doses 4 weeks 2–8 °C Phase III (25,800) Randomised , observer-blinded, Placebo controlled. Bharat Biotech reported an interim efficacy of 78% in its phase 3 trial Koshy , Jacob (21 April 2021).  "Updated data from Covaxin phase 3 trial shows 78% efficacy" .  The Hindu .  ISSN   0971-751X

34. Moderna Developers Country of origin Technology Doses ( Interval) Storage Pre-marketing study Post-marketing study Moderna , NIAID, BARDA, CEPI US RNA ( modRNA in lipid nanoparticles ) 2 doses 4 weeks −20 ± 5 °C Phase III (30,000) Interventional; randomized, placebo-controlled study for efficacy, safety, and immunogenicity. Positive results from an interim analysis were announced on 15/11/2020 and published on 30/12/2020 reporting an overall efficacy of 94%. Phase IV (10,000) Interventional non-randomized undergoing Promising Interim Results from Clinical Trial of NIH- Moderna COVID-19 Vaccine" .  National Institutes of Health (NIH) . 15 November 2020.

35. Johnson & Johnson Developers Country of origin Technology Doses ( Interval) Storage Pre-marketing study Post-marketing study Janssen Vaccines (Johnson & Johnson), BIDMC US Netherlands Adenovirus vector (recombinant Ad26) Single dose 2–8 °C Phase III (40,000) Randomized, double-blinded, placebo-controlled Positive results from an interim analysis were announced on 29/1/2021. An efficacy of 66% against mild and moderate symptoms, and 85% against severe symptoms Janssen COVID-19 Vaccine – ad26.cov2.s injection, suspension" .  DailyMed . U.S. National Institutes of Health. Retrieved 15 March 2021.

36. CoronaVac Developers Country of origin Technology Doses ( Interval) Storage Pre-marketing study Post-marketing study Sinovac China Inactivated SARS‑CoV‑2 ( vero cells) 2 doses 2–3 weeks 2–8 °C Phase III (33,620) Double-blind, randomized, Placebo controlled to evaluate efficacy and safety. Final Phase III results from various parts of globe reported efficacy below 70% but more effective in preventing severe cases "Estudo clínico que comprova maior eficácia da Coronavac é enviado para Lancet" .  CNN Brasil  (in Portuguese). Retrieved 18 April 2021

37. Other approved vaccines Vaccine Developers/Country Remarks/Usage/Efficacy Sputnik Light Russia On emergency use; undergoing phase III trial WIBP- CorV China Phase III trial showed 72.3% efficacy EpiVacCorona Russia On emergency use; undergoing phase III trial QazCovid -in Kazakhstan On emergency use; undergoing phase III trial Minhai COVID-19 vaccine China On emergency use; undergoing phase III trial CoviVac Russia 2 doses only 2 weeks apart; undergoing phase III trial EpiVacCorona Russia On both full time & emergency use; Phase III trail reports pending RBD- Dimer China Only vaccine to have 3 doses; Phase III trials reports pending

38. Approved COVID‑19 vaccines in Phase I–III trials Vaccine Developers/Country Type Trial phase Emergency use Authorisation Novovax US Subunit Undergoing phase III US EU NZ Aus Sanofi -GSK UK France Subunit Undergoing phase III US EU Canada Cure- Vac Germany RNA Undergoing phase III EU CoVLP Canada Subunit Undergoing phase III Canada SOBERANA 02 Cuba Subunit Undergoing phase III Cuba VLA2001 France Subunit Phase III trial started EU

39. Other vaccines awaiting emergency use authorization Vaccine Developers/Country Type Trial phase ZyCoV -D India Subunit III COVIran Barakat Iran Subunit III CIGB-66 Cuba Subunits III Nanocovax Vietnam Subunit II Bio E COVID-19 India US Subunit II UB-612 Brazil Subunit II GRAd-COV2 Italy Adenovirus vector II MVC-COV1901 Taiwan Subunit II COVAX-19 Australia Subunit II AG0302 Japan DNA plasmid II IIBR-100 Israel Vesicular stomatitis virus Pre-clinical HGC019 India US RNA Pre-clinical BBV154 India Adenovirus vector Pre-clinical

40. Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

41. Distribution 1.9 billion COVID-19 vaccine doses administered worldwide Licensed vaccines should be available and affordable for people at the frontline of healthcare and having the greatest need Several companies plan to initially manufacture a vaccine at artificially low pricing, then increase prices for profitability later if annual vaccinations are needed and as countries build stock for future needs

42. Inequality concerns WHO, CEPI, and GAVI have expressed concerns that affluent countries should not receive priority access to the global supply of eventual COVID‑19 vaccines Although 9 percent of the world's population lives in the 29 poorest countries, these countries received only 0.3% of all vaccines administered Brazil vaccinated twice more white than black people and noticed the fact that the mortality of is higher in the black population

43. Misinformation & hesitancy Anti-vaccination activists and other people spread a variety of rumors, including overblown claims about side effects

44. Encouragement by public figures Current and former heads of state and government ministers have released photographs of their vaccinations, encouraging others to be vaccinated including Joe Biden, Barack Obama , Narendra Modi, the Dalai Lama, Justin Trudeau, Kyriakos Mitsotakis, Zdravko Marić, Olivier Véran Many musicians, actors,TV personalities, athletes also encouraged

45. Adverse events Injection-site events mainly grade 1 or 2 in severity Lasted a mean of 2.6 and 3.2 days after the first and second doses respectively M/C pain after injection > 80% Rest fever, headache, fatigue, myalgia, arthralgia, nausea, vomiting ; severe grade rarely Hypersensitivity reaction rarely crosses 1%

46. Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

47. Initiation As of early May 2020, there were over 30 vaccine candidates in development in India, many of which were already in pre-clinical trials

48. Serum Institute of India & Covishield World's largest vaccine maker In Feb’2020, SII had begun animal trials of vaccine candidates In Aug’2020, SII received approvals for phase 2 and phase 3 trials of its version of a vaccine being developed by AstraZeneca and the University of Oxford's Planned to manufacture 1.5 and 2.5 billion doses per-year

49. Bharat Biotech & Covaxin ICMR partnered with Bharat Biotech in May 2020 to develop a COVID vaccine entirely within India In June 2020,received DCGI approval to begin phase 1 and phase 2 trials on its vaccine On 3 March 2021, Bharat Biotech reported that Covaxin showed an efficacy of 78% in its phase 3 trial Expanded its production capabilities for Covaxin to 700 million doses per-year Covaxin showed 81% efficacy in third phase trials, says Bharat Biotech" ( https://scroll.in/latest/ 988469/covaxin-showed-81-efficacy-in-third-phase-trials-says-bharat-biotech). Scroll.in . 3 March 2021. Retrieved 4 March 2021.

50. Cadila Healthcare Began vaccine development in March 2020 Including a viral vector vaccine and a DNA plasmid vaccine In mid-July 2020 held early human trials of its vaccine candidate ZyCoVD Received approval for phase 3 trials in January 2021 Expecting to receive emergency authorization shortly

51. Dr Reddy’s Partnered with the Russian Direct Investment Fund (RDIF) to conduct phase 3 trials of the Sputnik V vaccine Also working with the RDIF on approval of "Sputnik Light"—a regiment of Sputnik V consisting only of the first dose

52. Launching vaccination programme On 1/01/21, the DCGI approved emergency use of the Covishield On the following day, the Covaxin also approved Standard emergency use authorization to Covaxin later on in March’21 On 12 April, the DCGI approved Russia's Sputnik V vaccine for emergency use Began its vaccination program on 16 th January operating 3,006 vaccination centers on the onset Concerns about low turnout, due to a safety concerns

53. Second phase From 1 st march covering all residents over 60 Between the ages of 45 and 60 with one or more qualifying co-morbidities Any health care or frontline worker that did not receive a dose during phase 1 From 1 April, eligibility extended to all residents over 45 PM called for a four-day “ Teeka Utsav " from 11 to 14 April to encourage vaccination

54. Third phase From 1 st may Eligibility to all residents over the age of 18 On 25 May, India exceeded 200 million vaccine doses administered

55. Vaccine Maitri Humanitarian initiative from Jan’21 Aims to leverage the country's pharmaceutical industry to export Indian-manufactured vaccines to other countries Had donated over 64.5 million vaccines to 85 countries Canada, Bahrain , Brazil , South Africa , Argentina, Iran notable recipients WHO heaped praise for this great effort

56. State wise data’s Gujarat, Karnataka, Maharasthra, Rajasthan, Uttar Pradesh & West Bengal are the states with more than 10 million jabs Tripura & Ladakh have vaccinated more than it’s 15% of the populations

57. Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

58. Super-spreading events Transmission of infection in Quarantine hotels Infection from Asymptomatic & pre-symptomatic individuals More indoor transmission than outdoor transmission Nosocomial infection despite adequate personal protection

59. Viable SARS-CoV-2 detection in the air; stayed infectious in the air for up to 3 h with a half-life of 1·1 h Identified in air filters and building ducts in hospitals Transmission between caged animals connected only through air duct No strong or consistent evidence to refute the hypothesis of airborne SARS-CoV-2 transmission Limited evidence to support other dominant routes of transmission: respiratory droplet or fomite Lednicky JA, Lauzard M, Fan ZH, et al. Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. Int J Infect Dis 2020; 100: 476–82.

60. Modes of prevention Hand hygiene Respiratory hygiene Social Distancing High risk group

61. Home quarantine rules Stay in well-ventilated room Restrict movement Using separate bathroom Follow respiratory hygiene/hand hygiene specially if symptomatic Avoid visitors in house Household members use separate bathroom & bedroom Avoid sharing household items To remain free from any kinds of rumour & stigma

62. Planning & development Current scenario Vaccine types & mechanisms Efficacy & action against variants Chief vaccines & trial results Other approved vaccines & vaccines pending authorization Distribution & inequality concerns India’s vaccine development & distribution General prevention strategies Hospital preparedness

63. Components How Should U.S. Hospitals Prepare for Coronavirus Disease 2019 (COVID-19)? Ann Intern Med. Published online March 11, 2020. doi:10.7326/M20-0907

64. Preparing for Triage At healthcare facility entrance to direct patients to Telemedicine facility Those with fever and respiratory symptoms like cough or breathing difficulty – immediately proceed to triage or registration desk Additional symptoms to consider Chills Repeated shaking with chills Muscle pain Headache Sore throat New loss of taste or smell https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

65. Protecting the healthcare personnel Install physical barriers (e.g. glass/plastic screens) at registration desk with 1 m at-least distance Identify isolation rooms or separate well-ventilated rooms for suspected patients Provide masks/ face covers for all patients visiting the HCF Convenient access to hand hygiene products Should wear gowns, gloves, face mask, and eye protection Only doing emergency procedures Mandatory telemedicine facilities

66. Sample visual alerts to post at facility entry

67. Airborne Infection Control: Ventilation

68. Fans in isolation wards – key factors Cool ambient temperature through dissipation of radiant heat Provide directionality in order to improve ventilation Direction of fans should deflect air away from health care workers

69. How to ensure surgeons safety Elective surgeries should be postponed Take precautions when performing Aerosol-Generating Procedures (AGPs) Operating rooms should be allocated and signs posted on the doors to minimize staff exposure If no general anesthesia: Patient should continue to wear the surgical mask If general anesthesia used: Place a HEPA filter between the Y-piece of the breathing circuit and the patient's mask, endotracheal tube or laryngeal mask airway If available, use a closed suction system during airway suctioning https://journals.lww.com/annalsofsurgery/Documents/Managing%20COVID%20in%20Surgical%20Systems%20v2.pdf https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus https://doi.org/10.1007/s12630-020-01617-4

70. Take home messages COVID vaccination is one of the greatest & fastest scientific discovery of mankind India didn’t lag behind in technological expertise to build a top quality vaccine indigenously US EU nations have vaccinated in pretty organized manner India had started vaccination in a quite efficient manner but anti-vaccination campaigning dampened the spirit initially The second wave & appearance of variants have compelled citizens to take jabs currently Prevention strategies should be very proper in health care settings Telemedicine facilities needs to be encouraged

71. Thank you………

72. Hand hygiene DO Hand washing with soaps & water for at-least 40 sec or using alcohol based handrubs Especially after you have been in a public place, or after blowing your nose, coughing, or sneezing Of your hands and rub them together until they feel dry DONT Touch your eyes, nose, and mouth with unwashed hands touch surfaces like door knobs and door bells, elevator buttons,handrails , support handles, chair backs, atm , mobiles

73. Respiratory hygiene Do Use handkerchief/tissue while coughing/sneezing Throw the tissue immediately in dustbin Cover sneeze into bent upper arm Wash hands immediately DONT Spit in open Use other ways of covering face

74. Social distancing Do STAY AT HOME UNLESS ABSOLUTELY NECESSARY KEEP A DISTANCE OF AT LEAST ONE METER BETWEEN YOURSELF AND ANOTHER PERSON Dont DO NOT HOLD EVENTS WHEREPEOPLE HAVE TO GATHER (EVEN IF IT IS A CORNER MEETING WITH THREE OR FOUR FRIENDS, OR AN EVENING CHAT ON THE CHAUPAL) •DO NOT GO TO CROWDED PLACES LIKE MARKETS, SHOPPING, MELAS, PARTIES •DO NOT USE PUBLIC TRANSPORT

75. ZyCoV -D vaccine DNA vaccine Plasmid expressing SARS-CoV2 protein First of its kind On its way to becoming the 1 st DNA vaccine to get approval 1 st vaccine to get authorization between age group 12-18

76. Vaccines approved below 18 yrs of age Pfizer approved for age 12-16 Pfizer/ Moderna / Novavax /Johnson undergoing trial for children from 6 months to 11 years Covaxin undertaking trial in children Bharat biotech’s nasal vaccine incorporated children

77. Clotting abnormalities in OA vaccines Blood coagulation with thrombocytopenia to be listed as very rare S/E of Vaxzevria Generally occurring within 2 weeks Mostly in women < 60 years Among 20 million vaccination, only 25 cases reported Examples: CVT/ splanchnic venous thrombosis Pathology similar to HIT Possibly antibody developing against P4 All cases notified from Europe only; notably UK Benefit outweighs risk